Ontario doctors who have been disciplined for matters related to sexual abuse are often able to continue to practise medicine.
When a patient comes forward with a complaint about a doctor, it is typically handled by the College of Physicians and Surgeons of Ontario, the body that regulates the practise of medicine in the province.
On its website, the college says it investigates complaints "each year" from patients "who believe their physician crossed a sexual boundary with them."
The college website says these complaints include concerns about privacy and respect, inappropriate gestures or comments made by physicians, unnecessary or improper physical examinations, as well as sexual contact or assault.
Carolyn Silver, senior counsel for the college, said it prosecutes all cases in which an allegation of sexual abuse is raised "no matter what the conduct."
However, not all types of sexual abuse, as defined under Ontario’s Regulated Health Professions Act, prompt an automatic revocation of a physician’s certificate of registration.
"There are frank sexual acts that are set out in the legislation that mandate revocation and the circumstances are not relevant, consent in all of sexual abuse is not relevant," Silver said, citing sexual intercourse and a doctor making oral-to-genital, or genital-to-genital contact with a patient.
Silver said legislation sets out a "range of penalties" for such cases, which include the suspension of a physician’s certificate of registration to full revocation, which leaves a doctor unable to apply for reinstatement for five years. Acts deemed to be less serious receive lesser punishments.
But Silver said the college discipline committee has ordered revocation in cases where it is not mandated by the letter of the law, when it is in the public interest to do so.
"There are many cases where there are very serious findings of sexual abuse that revocation is not mandated under the legislation, yet the college requests it and it is ordered by the discipline committee and we have many, many examples of those cases," Silver said.
The college says this has happened 17 times.
Silver also said the college also has the ability to suspend doctors immediately when allegations of sexual abuse are raised.
Asked why cases are not automatically passed on to police, Silver said there is no mandatory reporting, but the college works often with police and vice-versa.
Silver said the defence counsel for doctors under investigation have challenged this information sharing in some cases and there are legislative provisions that limit how the college may share information generally.
The college has pushed for the legislation to be changed so that it is not limited in its ability to share information.
“We believe that the sharing of information is certainly in the public interest,” she said.
Yet a CBC News Toronto investigation has examined several cases of doctors working within the Greater Toronto Area who have been the subject of multiple complaints, but who remain able to practise medicine in Ontario.
In the case of Sami Karkanis, a doctor who specializes in obstetrics and gynecology, the first complaint came before the college discipline committee in 2009.
A former patient accused Karkanis of attempting to have sex with her during an examination.
Karkanis said he believed that the two had formed a relationship.
While Karkanis denied the allegations against him, the college discipline committee found that he had committed professional misconduct.
A joint submission was later made by college counsel and the doctor’s own counsel, which was accepted.
Karkanis was reprimanded, suspended for five months, fined $10,000, required to attend an ethics course at his own expense and barred from seeing female patients without an approved female chaperone being present.
More recently, Karkanis has been accused of sexually abusing another female patient during a pelvic examination six years ago.
She testified that after an assistant left the room, a further exam occurred and Karkanis "put his fingers in her vagina and moved them in and out repeatedly and touched or rubbed her clitoris and asked, not in a medical manner but in a sexual one, 'how does that feel.'"
The committee found that "Karkanis' conduct of this examination was intentional, sexual in nature and was not for any medical purpose."
In a separate appointment that year, the patient alleges that he asked her if she likes “them big,” when they were discussing pain she was experiencing during intercourse.
Karkanis denies the allegations, but a college discipline committee has found that he sexually abused the patient who brought forward the complaint.
Karkanis’s lawyer, Jenny P. Stephenson, told CBC News that she is limited in what she can say, as her client will soon face "a hearing panel on penalty."
But she expects Karkanis "will appeal the decision respecting whether he actually engaged in the conduct alleged."
Karkanis is believed to currently be teaching medicine in the United Arab Emirates.
Another doctor, Eleazar Noriega, recently faced a pair of separate allegations – one from the mother of a young patient, another from a patient he once saw decades ago. These came a few years after he was disciplined for the sexual abuse of a different patient.
Noriega, a Toronto-based pediatrician, is represented by Stephenson, the same lawyer who represents Karkanis.
Stephenson told CBC News that Noriega was acquitted of the recent allegations regarding the younger patient, while the other set of recent allegations against him was overturned by a Divisional Court.
Two years ago, a college discipline committee found that Noriega had committed professional misconduct during his interactions with a female patient in the 1970s. But Noriega challenged that outcome in Divisional Court, which this past summer ordered the matter "remitted to a different panel for a new hearing."
Two years before that, a mother alleged that she had seen Noriega touch her eight-year-old child’s breasts inappropriately during an examination. However, a college discipline committee ruled that the college had "not established" that Noriega engaged in either "disgraceful, dishonourable or unprofessional conduct," or the sexual abuse of his young patient. The discipline committee found the testimony of the patient’s mother to be "inconsistent and improbable in many respects."
Years before either of these allegations were raised, the college found in 2003 that Noriega had committed professional misconduct by sexually abusing a patient.
Noriega pleaded no contest to those allegations and was then reprimanded by a college discipline committee. He also served a suspension and was required to have an approved monitor present when examining female patients.
While not speaking on behalf of any particular client, Stephenson noted "the fact that a doctor is involved in disciplinary proceedings for sexual abuse of a patient does not, of course, mean that the doctor has actually sexually abused anyone."
Additionally, Stephenson said that for a physician, the loss of a licence is a "professional death knell," with the potential to take away "everything he or she has worked for over a lifetime."
Marilou McPhedran, a lawyer who chaired two task forces on patient sex abuse, said most doctors want to see a tough system in place that will ensure that they do not refer their patients to someone who will abuse them.
But McPhedran told CBC News that is only possible if "there is a very close scrutiny of any doctors or other health professionals who have a history of sexual abuse where there is already a finding."
McPhedran sees a trend where regulatory bodies and court judges are inclined to impose only mandatory or minimum restrictions, using the law "as a ceiling," rather than as a platform to push where discretion can be exercised.
"They could be revoking licences when they’re not; they’re not using their discretion to revoke," she said, contradicting the CPSO's position that this occurs regularly when appropriate.
"They’re doing minor suspensions and then they’re allowing a return into the profession, and that’s wrong."
Do No Harm: Doctors and Sexual Abuse continues this week online, on radio and tonight on CBC News Toronto television, starting at 5 p.m.